Ecological momentary analysis of the relations among stressful events, affective reactivity, and smoking among smokers with high versus low depressive symptoms during a quit attempt

Abstract

Aims: To assess whether individuals trying to quit smoking who have high depressive symptoms (HD), compared with low depressive symptoms (LD): (1) report more frequent stressful events (SEs), (2) are more likely to smoke after SEs, (3) experience greater acute or persistent changes in affect after an SE, and (4) are at greater risk of smoking following affective changes.

Design: Smoking cessation data were analyzed using multi-level path modeling to examine the moderating effects of depressive symptoms on relations among SEs, subsequent affect, and smoking.

Setting: An academic research center in Central New Jersey, USA.

Participants: Seventy-one adult treatment-seeking daily smokers recruited from 2010 to 2012.

Measurements: Baseline depressive symptoms [HD: Center for Epidemiological Studies Depression Scale (CES-D) ≥ 16 versus LD: CES-D < 16]; and real-time ecological momentary assessment (EMA) reports of SEs, affect, and smoking assessed during 21 days post-quit.

Findings: Multi-level models indicated that HD smokers were more likely than LD smokers to report stressful events [odds ratio (OR) = 2.323, P = 0.009], but had similar post-stress acute affective changes (negative affect: b = -0.117, P = 0.137, positive affect: b = 0.020, P = 0.805). Only HD smokers reported increased negative affect (NA) (b = 0.199, P = 0.030) and decreased positive affect (PA) up to 12 hours later (b = -0.217, P = 0.021), and greater lapse risk up to 24 hours after an SE (OR = 3.213, P = 0.017). The persistence of elevated NA and suppressed PA was partially explained by increased odds of subsequent SEs among HD smokers. However, the heightened stress-lapse association over 24 hours found in HD smokers was not fully explained by sustained aversive affect or subsequent SEs.

Conclusions: Depressed and non-depressed smokers trying to quit appear to experience similar acute affective changes following stress: however, depressed smokers experience higher rates of exposure to stress, longer-lasting post-stress affective disturbance and greater risk of smoking lapse 12-24 hours after a stressful event than non-depressed smokers.

Keywords: Depressive symptoms; ecological momentary assessment; negative affect; positive affect; smoking cessation; stress reactivity.

Figure 1. Simplified short-term and long-term models

a. Short-term models (over 2-12 hours) b. Long-term models (over 12-24 hours) Covariates in the model are not depicted in the figures (see Table 2 & 4). Dichotomized depressive symptom level (HD vs. LD) was entered as a level-2 moderator. Note: m (dotted gray lines): moderating effects of baseline depressive symptoms (HD: CES-D ≥ 16 vs. LD: CES-D < 16)

Figure 1. Simplified short-term and long-term models

a. Short-term models (over 2-12 hours) b. Long-term models (over 12-24 hours) Covariates in the model are not depicted in the figures (see Table 2 & 4). Dichotomized depressive symptom level (HD vs. LD) was entered as a level-2 moderator. Note: m (dotted gray lines): moderating effects of baseline depressive symptoms (HD: CES-D ≥ 16 vs. LD: CES-D < 16)

Figure 2

Percentage of reports where stressful events were reported by High vs. Low baseline depressive symptoms. “Any Stress Report” reflects a report that new, ongoing, or both new and ongoing stressful events were endorsed.

Figure 3. Simplified long-term models (over 12- 24 hours)

Covariates in the model are not depicted in the figures (see Table 4). Two separate models with and without recent stressful events were tested in each model. The coefficients in the model with recent stressful events are depicted in gray. Note: m (dotted lines): moderating effects of baseline depressive symptoms (HD: CES-D ≥ 16 vs. LD: CES-D < 16)